Free Treatment Offer
Check to see if you qualify for a free or discounted Ketamine treatment:
Health Insurance:
Blue Cross
Meridian
Medicaid
Medicare
Ohio Workers Comp
None
Not Listed Here
How old are you?
Less than 18 years old
18 to 29 years old
30 to 59 years old
60 years old or greater
Diagnosis (check all that apply)
Depression
Anxiety
Suicidality
PTSD
OCD
Addiction
Chronic Pain
Fibromyalgia
Neuropathy
Migraines
CRPS / RSD
Neck/Back Pain
Multiple Sclerosis
How long have you had your diagnosis(es)?
0-4 years
5-9 years
10-14 years
15-24 years
25 years or greater
Are you currently prescribed medications?
Yes
No
Have you had psychiatric hospitalizations?
Yes, within the last 10 years
Yes, greater than 10 years ago
No, never
Who currently follows your psychiatric care?
Primary Care Provider
Psychiatrist
Mental Health Nurse Practitioner
I am not followed by anyone for my mental health
Do you have or can you get a referral for treatment?
Yes
No
Full Name
Email
*
Phone
*